Mental Illness and its Damaging Stigma
There has been a gradual change in the public perception of mental health challenges over the past decade. More people speak openly about their experiences with care. Celebrities disclose their diagnoses not just when they have been defamed by the press but with the intent to raise awareness.
Television shows often include characters with mental health disorders that add to their story (like Randall in This is Us and Devi in Never Have I Ever), and are not exclusively portrayed as different or violent.
Yet, the general view of mental health needs is still predominantly negative in American society. Psychiatrists report that they have patients’ parents dispose of their children’s medication when they find it or tell them not to take it. Other mental health professionals have reported having patients who delayed coming in until they no longer had a choice because they thought “I would just get over it” or “I am just a girl and girls are emotional.”
This stigma can directly impact people’s job opportunities and livelihoods as well. In many states in this country, state licensing applications to practice medicine require physicians to disclose if they have ever suffered from a diagnosed mental health challenge, right next to inquiries about them having committed serious crimes.
This not so subtle equating of mental health needs treatment with felonies, causes physicians, who have some of the highest rates of suicide of any profession, to deny themselves treatment, fearing potential licensing consequences or other possible repercussions at work.
Half of all lifetime cases of mental illness in the U.S. begin by age 14 and 75% by age 24. Yet, the average delay between the onset of symptoms and intervention is 8-10 years. Although approximately 44 million American adults experience a mental health challenge in any given year, fewer than half will receive treatment because mental illness stigma keeps people from getting help.
What Causes the Stigma?
The Media Does its Part
When someone is asked to describe mental illness, it is likely that he/she will reference a movie like “A Beautiful Mind,” “One Flew Over the Cuckoo’s Nest, or “As Good As It Gets.” Each of these movies portrays neurodivergent individuals as unable to function normally within society.
However, the statistics paint a quite different picture. Only a fraction of people with mental health challenges are incapable of functioning healthily within society. But by the media consistently reinforcing this stereotype, the perception it falsely presents becomes the reality in most people’s minds.
News focusing on violent acts committed by these individuals serves to further intensify this stereotype. The truth is, only a very small fraction of them become violent and harm themselves or others. However, by highlighting the profile of these few instances, many Americans associate mental health challenges with violence.
Where’s the Education System?
Until the recent advent of MRI and PET scans, doctors and other practitioners were extremely limited in their understanding of what caused mental health challenges and how to treat them. However as research continues to advance, the causes and effective treatments for mental illness are becoming much clearer.
But, our education system lags far behind in sharing the evolving understanding of mental health challenges. Until not long ago, a student graduating from high school had never received any information about mental health from school, which affects roughly half of the population over their lifetimes. Lacking accurate information, how can we hope to challenge the perceptions being fed to us by the movie and news industries?
The Stigma’s Devastating Consequences
The significant degree of stigma associated with mental health challenges prevents many struggling with it from seeking treatment. It’s a double whammy. Not only do these folks need help, but they also must contend with being labeled as “crazy” and being ostracized if their friends, coworkers, boss, or neighbors become aware of their mental health challenges. Petrified of being “discovered,” they avoid treatment, skip medications, and lose self-esteem.
Studies show that prejudice and discrimination against those who suffer from mental health challenges are pervasive, and more often than not as debilitating as the mental health challenge itself. It is commonplace for those with known mental illnesses to be denied housing and employment, discriminated against at their jobs, and mistreated by family, friends, and religious organizations.
The cost of the stigma of mental health challenges is high for individuals who have it, their families, our communities, our country, and the world. Whereas it is known that treatment works, its unnecessary delay can be devastating for everyone. The numbers say it all:
- 37% of students age 14 and older with a mental health condition drop out of school … the highest dropout rate of any disability group.
- 70% of youth in state and local juvenile justice systems have a mental illness.
- 26% of homeless adults in shelters live with serious mental illness.
- Depression is the leading cause of disability worldwide and is a major contributor to the global burden of disease.
- Serious mental illness costs the U.S. $193.2 billion in lost earnings every year.
- 90% of those who died by suicide had an underlying mental illness.
The American Difference
According to Denise Rousseau, Ph.D., Professor of Organizational Behavior and Public Policy at Carnegie Mellon University’s Heinz College, “As individuals, families, companies, and insurers face a potentially different landscape with mental health due to COVID-19, it’s likely the U.S. will take a deeper dive into how emotional issues are handled here compared to other countries. That could have a profound impact on the way mental health treatment is handled here.”
“In Europe, for example, mental health is seen as the responsibility of the community, and in Asia, it’s seen as the responsibility of the family, but here it’s viewed as a challenge for an individual,” she says.
“Because of that, there may be less of a feeling of overall support, especially from an employer, as well as from friends and family members. Someone may think he or she will see pushback in the form of losing promotion opportunities, being seen as fragile, and losing the respect of people they love. That belief can be pervasive.”
Another challenge in the U.S. going into the pandemic, Rousseau adds, “is that it’s less acceptable to be sad here. There’s a culture of positivity that can feel almost toxic to someone who is experiencing feelings that are normal in a pandemic, like grief, loss, pessimism, and irritation.”
“Feeling down is part of life. It’s not a problem to resolve aggressively, it’s an acknowledgment that we can’t be happy all the time. Mental health isn’t about trying to get people to feel upbeat no matter what, it’s about building resilience. As we all navigate through this together, that will hopefully become more prominent.”
Why Let this Crisis Go to Waste?
“Stigma has been a huge barrier for many people, especially because some might think they’ll be punished by their employers or that they’re weak for getting help,” said Cheryl Carmin, Ph.D., a psychologist at The Ohio State University Wexner Medical Centers. “But it’s very possible that greater acceptance of mental health care is part of the new normal.”
We need to focus and take advantage of this upside of the surging stress and anxiety due to COVID-19. “As more people experience emotional difficulties, mental health may become more destigmatized—and that may lead more people to seek help for mental health issues,” Carmin says.
Carmin believes: “As the stigma lifts and the culture changes, the sense of shared trauma and experiences are making it easier for people to talk not just about their own struggles, but to recognize those issues in others.”
“COVID-19 is prompting conversations that have been needed long before the pandemic hit,” she says. “We’re talking about what employers should be doing, what public health officials should be doing, what role healthcare providers can play. We’re talking about compassion fatigue, anxiety, depression, all those difficult topics. And that’s good to get it all out in the open.”
In other words, the COVID-19 pandemic may become the great psychological equalizer. Practically everyone is self-isolated at home, trying to juggle managing a household with work, and dealing with uncertainty and grief. To different degrees, we are all experiencing how anxiety impacts our daily lives.
And this includes those in management. Not only are they dealing with their employees’ stress but they are also dealing with their own. Although depression is currently the prime cause of disability worldwide, many employers and managers are openly talking about mental health in the workplace for the first time.
You can see the change in social media as well. Social media has been known to trigger depression in young adults due to what is called “social comparison.” This often manifests itself as feeling like no one else is stressed or sad or struggling because everyone looks happy and appears to be having lots of fun on social media; by comparison, the sad and stressed hapless individual feels like “something is wrong with me.” But not so many people look like they are having so much fun anymore.
Some college students maintain a “finsta” (a “fake-Instagram” account) they share with a select group who trust to see their true selves. However, during COVID-19, nearly everyone—from influencers to celebrities to students—are sharing their vulnerability about their actual experiences and emotions.
This trend of becoming more real may lead to more authentic social connections or even a decrease in depression and loneliness. When viewed in this light, the vulnerability being manufactured by COVID is quite positive and can be a force for change long after the pandemic ends.
And COVID has shown how inextricable mental health is from physical health. When you talk about a lack of personal protective equipment (PPE), a discussion of the mental health repercussions immediately follows. And you cannot talk about patients who are dying of COVID-19 without talking about grief.
In the U.S., practically half of all adults will experience mental illness during their lifetime, practically equal to the rates of those who suffer from heart disease. Imagine telling someone with heart disease that he/she is weak for having it, or there shouldn’t be access to care because it is less important or valued. That has essentially been the line with mental illness, and now, due to the pandemic, it may finally stop.
So instead of looking at the post-COVID-19 mental health future through a lens of impending doom, this moment can be used as the impetus for the long-overdue transformative changes that mental health care has always deserved.
It will be an opportunity to invest in expanding access to affordable mental health care coverage to everyone in need, through a variety of platforms and venues. And perhaps even more essentially, it’s the opportunity to make mental health care coverage and reimbursement for mental health care equal to physical health care, treating it like any other illness — which is what it has always been.